Musculoskeletal case studies for medical students

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History A 72 year old man fell down the stairs. Neurovascular intact, no other injuries. Hypertensive, no other major illnesses.
Initial X ray
Description AP X ray
X ray
Description Lateral X ray
Problem The 72 year old male with a painful hip after falling down the stairs. How this was treated, and why?
X ray after treatment
Description After ORIF
Post management further view
Classification There is an extracapsular fracture of the right proximal femur. The fracture extends into the subtrochanteric region, and the lesser trochanter is involved.
Discussion of management The fact that the lesser trochanter us undermined makes the fracture unstable. After resuscitation the patient was taken to theater and a cephalomedullary intramedullary rod was inserted. Extracapsular fractures heal well, but tend to shorten and drift into varus angulation, if treated conservatively. The patient's age makes him susceptible to the problems of immobilisation in bed, such as pressure sores and pulmonary embolus. For these reasons these fractures are preferably treated operatively. A sliding hip screw and plate would also have been an acceptable option. In this case, because of the fracture extended below the lesser trochanter, a cephalomedullary intramedullary device was opted. This offers increased stability compared to a sliding screw and plate.


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